2019-131, due care criteria complied with

Straightforward notification, findings letter, short illness,
decision not to undergo treatment.

The patient, a man in his seventies, was diagnosed with pancreatic cancer with metastases to several organs three months before his death. His condition was incurable. He could only be treated palliatively. The patient had witnessed several examples of suffering at the end of life in his immediate circle. Because of this, he was clear in his own mind long before he fell ill that he did not want to go through suffering of this kind and that he wanted to take control of his own fate. He did not wish to become reliant on others to perform activities of daily living such as getting out of bed, washing and eating.

At the time of his diagnosis, the patient still felt relatively well. He therefore made a considered decision not to undergo  hemotherapy because what he might be expected to gain in terms of a longer life did not, in his view, offset the loss in terms of quality of life resulting from that treatment. In the weeks before his death, the patient’s condition deteriorated sharply. He was no longer able to eat and could only drink a little, and if he did so he immediately became nauseous. The patient quickly became weak and was almost completely bedridden. His loss of independence and dignity left him, in his opinion, with ‘no life’. Lying in bed waiting for complications (high intestinal obstruction) or until he became emaciated was not in keeping with his character.

The patient suffered from his increasing dependency. He was accustomed to being in charge of his own life and was aware that this was becoming increasingly difficult. He did not wish to wait for the illness to take its course and wanted a dignified end to his life. The patient experienced his suffering as unbearable.

The physician was satisfied that this suffering was unbearable to the patient and with no prospect of improvement according to prevailing medical opinion. There were no alternative ways to alleviate his suffering that were acceptable to the patient. The documents made it clear that the physician and the specialists had given him sufficient information about his situation and prognosis.

The patient had discussed his wish for euthanasia with the physician shortly after his diagnosis. He did not change his mind in subsequent discussions. His experience of long-term illness in other people had given the patient clear ideas about what kind of death he viewed as lacking dignity and how things could be done differently. These considerations lay behind his decision to request euthanasia. He had also discussed his decision with his partner, children and grandchildren. They were all reconciled to his decision. Six days before his death, the patient asked the physician to actually perform the procedure to terminate his life. The physician concluded that the request was voluntary and well considered.

The physician consulted an independent SCEN physician who concluded that the due care criteria had been complied with. The physician performed the euthanasia using the method, substances and dosage recommended
in the KNMG/KNMP’s ‘Guidelines for the Practice of Euthanasia and Physician-assisted Suicide’ of August 2012.

The committee found that the physician had acted in accordance with the due care criteria.